Single-stage extensive replacement of the thoracic aorta: the arch-first technique.
Single-stage extensive replacement of the thoracic aorta: the arch-first technique.
复制标题
胸主动脉的单阶段广泛置换：弓优先技术。
DOI：
10.1016/s0022-5223(99)70473-3
复制
发表时间：
1999
影响因子：
6
通讯作者：
N. Kouchoukos
中科院分区：
文献类型：
--
作者：
C. Rokkas;N. Kouchoukos
研究背景：一期广泛性胸主动脉置换术通常需要停循环一段时间，在与弓状血管吻合之前进行移植物与下降主动脉的吻合。为了最大限度地减少脑缺血的时期，并减少潜在的神经损伤，我们开发了一种替代technology.MethodsIn 6例广泛的动脉瘤，涉及整个胸主动脉，通过双侧开胸手术，在前第四肋间空间与横向胸骨切开术获得曝光。在主动脉弓血管计划吻合部位的对面，将一个10 mm的移植物固定在主动脉移植物上。在循环停止的单个时间段（34-46分钟）期间，将主动脉移植物连接到包含弓状血管的主动脉袖带。然后将移植物夹在两侧，并用冷血液灌注足弓20至36分钟。远端主动脉吻合术完成后，通过10 mm移植物建立顺行灌注。近端主动脉吻合术进行last.ResultsNo患者持续永久性神经功能缺损。所有6例患者出院hospital.ConclusionsThe“弓第一”技术，结合双侧横胸廓切开术，允许迅速更换胸主动脉与可接受的时间间隔的低温停循环，并尽量减少逆行动脉粥样硬化栓塞的风险，建立顺行灌注。（《胸血管外科杂志》1999; 117：99-105）
BackgroundSingle-stage extensive replacement of the thoracic aorta usually involves a period of circulatory arrest with performance of the graft–to–lower descending thoracic aorta anastomosis before performing the anastomosis to the arch vessels. To minimize the period of brain ischemia and reduce the potential for neurologic injury, we developed an alternative technique.MethodsIn 6 patients with extensive aneurysms involving the entire thoracic aorta, exposure was obtained via a bilateral thoracotomy in the anterior fourth intercostal space with transverse sternotomy. A 10-mm graft was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. During a single period of circulatory arrest (34-46 minutes), the aortic graft was attached to a cuff of aorta containing the arch vessels. The graft was then clamped on either side, and the arch was perfused with cold blood for 20 to 36 minutes. After the distal aortic anastomosis was completed, antegrade perfusion was established via the 10-mm graft. The proximal aortic anastomosis was performed last.ResultsNo patient sustained a permanent neurologic deficit. All 6 patients were discharged from the hospital.ConclusionsThe “arch-first” technique, combined with a bilateral transverse thoracotomy, allows expeditious replacement of the thoracic aorta with an acceptable interval of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by establishing antegrade perfusion. (J Thorac Cardiovasc Surg 1999; 117:99-105)